Overview of Peritoneal Dialysis
Peritoneal dialysis (PD), a method of dialysis where a solution enters the abdomen and helps cleanse the blood of toxins, is not widely used in the United States. In fact, less than 7% of patients on dialysis in the U.S. use it, whereas in Canada, more than half of all dialysis patients use this method.
Some studies and records from around the world have suggested that PD may actually offer a higher survival rate in the early stages compared to hemodialysis (HD), another common method of dialysis that uses a machine to remove waste and extra fluid from the blood. Additionally, PD tends to be less expensive. In 2011, the average cost per patient for PD was $16,315 less than HD ($71,630 vs $87,945 respectively).
When starting dialysis, patients have the option to choose between PD and HD. This choice should be made keeping the patient’s unique needs and circumstances in mind. Interestingly, a large study in the U.S. involving more than 6,000 paired patients initiating dialysis in 2003 found a higher 1-year survival rate among PD patients compared to HD patients (85.8% vs 80.7%, p < 0.01). Despite these findings, 80% patients suffering from end-stage kidney disease in the U.S. begin with hemodialysis using a specially designed tube or catheter. This is somewhat surprising, as 60% of them continue using this method for at least three months, despite a higher risk of infection and death within the first 90 days due to bacteremia and sepsis from catheter use. So, even though HD is the more commonly used dialysis method, it seems that PD could be a safer and more cost-effective option for some patients.
Why do People Need Peritoneal Dialysis
As medical treatments evolve towards focusing on the highest quality, every healthcare provider has to consider the risks and benefits of different treatment approaches. For example, in the case of kidney treatments, they need to weigh the risks of starting hemodialysis, a method to clean the blood, early using a tube called a tunneled dialysis catheter (TDC) versus the benefits of starting a different type of dialysis called peritoneal dialysis, which uses a different type of tube known as a peritoneal dialysis catheter (PDC).
When a Person Should Avoid Peritoneal Dialysis
Peritoneal Dialysis (PD) – a type of treatment that uses the lining of your abdomen to filter waste and extra fluid from your blood – is not appropriate for everyone. Here are a few conditions where PD is not recommended:
1. If the patient has an “uncorrected abdominal wall hernia”, this means they have a gap in the wall of their abdomen that hasn’t been fixed with surgery. This can cause complications during PD.
2. If the patient has a “pleuroperitoneal shunt”, it means they have a tube that allows fluid to move from the lining of the lungs to the lining of the abdomen. This can interfere with the PD process.
3. If the patient has “abdominal adhesions”, this means they have bands of scar tissue inside the abdomen that can join together sections of tissue or organs that normally are separate. This could disrupt the PD procedure and potentially cause harm.
Equipment used for Peritoneal Dialysis
Medical professionals have several different methods to place a Peritoneal Dialysis (PD) catheter, which is a tube that helps remove waste and extra fluid from the blood of people diagnosed with kidney diseases. Success rates of this process vary and fall roughly in the range of 80-100%. The question arises; does the method used in placing this PD catheter impact its overall effectiveness? This isn’t easy to answer due to a multitude of variables, including patient health and different expertise levels of professionals performing the procedure.
Research has shown that the traditional approach, called open surgical placement, may lead to more complications. Such problems include catheter malfunction, leaks, and unintended catheter movements within the body. On the other hand, inserting the catheter via a less invasive procedure called laparoscopy tends to yield better results.
A study involving 113 patients compared two strategies – using real-time imaging to guide (fluoroscopic) the catheter placement versus using a laparoscopic approach. The results showed a higher rate of avoiding complications in the first group (42.5%) compared to the laparoscopic group (18.1%). However, after a year, both patient and catheter survival rates were comparable in the two groups.
It’s worth noting that both surgical and percutaneous (a procedure performed through the skin) methods have low complication rates when conducted by experienced professionals. For patients who are overweight, have had previous abdominal surgery, or have had inflammation of the peritoneum due to PD (PD-related peritonitis), the laparoscopic method of placing the catheter could be more beneficial.
On the downside, the surgical implantation of the PD catheter usually takes longer. This includes waiting for doctor appointments, scheduling surgeries, and getting cleared by physicians and anesthesiologists. Conversely, catheter placement guided by a kidney doctor (nephrologist) can be performed quickly, typically with sedating drugs in an outpatient setting. This can be especially helpful in an emergency scenario where dialysis needs to start on short notice.
Preparing for Peritoneal Dialysis
Starting treatment with Peritoneal Dialysis Catheter (PDC) – a type of treatment that uses the lining of your abdomen to filter your blood – is generally better for patients in terms of wellbeing, survival, and cost compared to Hemodialysis Catheter (HDC) – treatment that uses a machine to filter your blood. According to large past studies, patients using PDC had, in general, a higher chance of survival in the first 1 to 3 years of treatment as compared to those using HDC. The 2013 data from the United States Renal Data System also showed this survival advantage. Yet, it’s important to note that this could be due to healthier patients choosing PDC. Those who are not as healthy tend to start HDC, often following a sudden or serious illness.
Two recent studies from Canada explored if there was a preference for healthier patients choosing PDC. Both studies found that patients without diabetes starting PDC showed a survival advantage for longer than 2 years. In general, they also found no considerable difference in the risk of death between PDC and HDC. The exception was patients who started HDC treatment using a central venous catheter (CVC), a tube that provides access to your blood vessels. Those patients showed an 80% higher chance of death – but if a patient started HDC using AVF (a connection made by a surgeon between an artery and a vein) or an arteriovenous graft (AVG), a synthetic graft for dialysis, their chance of death was fairly similar to those starting PDC.
How is Peritoneal Dialysis performed
Peritoneal dialysis is a type of treatment which people use to clean their blood of waste products when their kidneys are not working well. This method has a few advantages over other forms of dialysis. For example, you can perform this treatment from the comfort of your home and you don’t have to go to a clinic every second day. This means performing the treatment is very manageable and uses a straightforward principle to remove toxins from your body.
If a doctor decides that peritoneal dialysis is a good choice for you, they will put a catheter (a thin tube) into your abdomen. They use different techniques to do this, so not everyone’s experience is the same. Once the spot where they put the catheter has healed, you will need to learn how to use it safely to do the dialysis. This involves going to a dialysis unit for two to three weeks and learning the clean and safe way to use the catheter. In this process, your blood will be cleaned by moving toxins out of it, through a membrane in your abdomen, and into a special fluid. This fluid holds the toxins for a set amount of time before you get rid of it.
You can often automate the process of peritoneal dialysis with a straightforward machine that connects to bags of the special fluid. This machine is set to put the right amount of fluid into your abdomen, hold it there for a certain period of time, and then automatically drain it. Depending on your needs and how well the toxins move through the membrane in your abdomen, you may need to repeat this process several times. If you don’t use the machine, then you will need to manually put in and drain the fluid, repeating this process throughout the day to ensure your blood is properly cleaned.
Possible Complications of Peritoneal Dialysis
The most serious problem that could happen after peritoneal dialysis (a treatment for kidney failure that uses your body’s own lining as a filter) is infection of the peritoneal cavity. This is the space inside your belly where the dialysis happens. An infection here is not just dangerous because it could stop the dialysis from working, but it can also be deadly.
You can lower the chances of getting an infection by using the peritoneal dialysis catheter (a tube used for the treatment) correctly, and by keeping everything as sterile as possible. If you’re a patient undergoing this procedure, you’ll receive a lot of instructions and guidance to help you do just that.
Most people with an infection will feel pain in their belly and notice that their dialysis fluid has turned cloudy. The diagnosis is generally confirmed by finding white blood cells, which fight off infections, in the dialysis fluid. If there are more than 100 white blood cells in each milliliter (roughly a fifth of a teaspoon) of fluid, it could mean there’s an infection. If that happens, it’s critical to take action right away, according to medical guidelines.
What Else Should I Know About Peritoneal Dialysis?
PD, or Peritoneal Dialysis, is a treatment that you can do at home. It allows you to manage your medical condition in a way that suits your lifestyle. It’s used to clean the blood of people whose kidneys can’t do the job. The good news is that patient outcomes for those using PD are just as good as another common treatment, Hemodialysis (HD).
Not only is PD often more comfortable and convenient, but it’s also much less expensive than other options. By adopting a “PD-first” approach – that is, trying this type of treatment before other options – patients can save money in the long run. This is important because the costs of treating kidney disease are growing.
Don’t underestimate the power of education either, understanding the process will significantly improve your experience and can even improve survival rates. Remember, it’s always best to discuss with your doctor to decide what treatment approach may be best for your specific situation.
